House May Delay Vote on Republican Medicare Reform Package

House Republicans' plan to bring a GOP-backed $350 billion Medicare reform package that includes a prescription drug benefit to the floor before the July recess may be delayed by work on two appropriations bills and a trade bill, CongressDaily/AM reports. Floor action on the Medicare package could come as early as Wednesday or Thursday, but aides said that a vote on the legislation could be pushed back to sometime after the recess. In addition to "juggling for floor time," Republican leaders must reconcile differences between similar versions of the Medicare legislation passed last week by the House Energy and Commerce Committee and the House Ways and Means Committee (Fulton, CongressDaily/AM, 6/25).

Under the version approved by the Energy and Commerce Committee, Medicare beneficiaries would be allowed to purchase drug coverage directly from private insurance companies. Seniors would pay a $250 annual deductible and a $35 monthly premium. Low-income seniors would be exempt from the premiums and deductible. The government would cover 80% of seniors' annual prescription drug costs up to $1,000, 50% up to $2,000 and no costs between $2,000 and $3,700, after which a catastrophic benefit would begin. The bill approved by the Ways and Means Committee would cap out-of-pocket costs at $3,800. In addition, the Energy and Commerce-passed measure includes a provision allowing drug plans to negotiate discounts with pharmaceutical companies greater than the price breaks Medicaid programs receive. The Ways and Means version includes a provision requiring Medicare beneficiaries to pay a $40 copayment for home health services, a provision that was dropped from the Energy and Commerce version (California Healthline, 6/24). Congressional sources predicted that the $40 copay will be included in the final version of the bill, CongressDaily/AM reports.

Some House members are planning to add language to the Medicare package that would reduce restrictions on drug reimportation. Rep. Gil Gutknecht (R-Minn.) has drafted an amendment that would allow U.S. residents to buy and reimport FDA-approved drugs sold in foreign countries at lower costs. "If we don't address the cost comparison of the equation, it's like building a house without a solid foundation," a Gutknecht spokesperson said (CongressDaily/AM, 6/25).

Meanwhile, a "backlog" at the Congressional Budget Office has forced a group of Senate moderates to delay introduction of a Medicare prescription drug bill. Sens. John Breaux (D-La.), Olympia Snowe (R-Maine), James Jeffords (I-Vt.), Orrin Hatch (R-Utah) and Charles Grassley (R-Iowa) have waited two months for the CBO to score their bill, but the office has been busy with other prescription drug legislation, according to a Senate aide. Introduction of the bill, designed as an alternative to a proposal backed by Senate Democrats, may be delayed until after the July recess (Serafini/Berynyk, CongressDaily, 6/24). The tripartisan plan would give seniors three options, which would contain the same Medicare drug benefit. Under the first option, seniors could remain in Medicare as it currently stands and receive the prescription drug benefit. The second option combines Medicare Part A and Part B to create a single deductible for hospital and physician services. Copayments and deductibles would be more costly, but the plan would offer more benefits, including enhanced preventive services and hospital coverage. The third option addresses Medicare+Choice, which would offer defined benefits packages, including drug coverage. In areas where Medicare HMOs have left the market, the government would contract with pharmacy benefit managers to offer drug coverage (California Healthline, 8/2/01).